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MD1 PCP > Transient Loss of Consciousness Interview > Flashcards

Transient Loss of Consciousness Interview Flashcards

1
Q

Describe reflex syncope

A

Vasovagal
Situational
- Cough
- Micturition

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2
Q

What are some reasons for a cardiac syncope?

A 
Arrythmias
- Tachycardia
- Bradycardia
Structural disease
- Aortic stenosis
- Myocardial ischaemia
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3
Q

What are two reasons for orthostatic hypotension?

A 
Primary autonomic failure
Secondary autonomic failure
- Diabetes
Drug induced
- Diuretics
- Vasodilators
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4
Q

Do you have to establish if there was true loss of consciousness?

A

Yes

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5
Q

What are some conditions that could be mixed up for TLOC?

A

Vertigo
Disequilibrium
Pre-syncope
Non-specific dizziness

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6
Q

What is the prodrome for vasovagal syncope?

A

Usually present
Includes feeling of light-headedness and “wobbly” legs, vision going dim, noises sounding distant
May remember start of collapse

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7
Q

What is the prodrome for cardiac syncope?

A

Usually not present

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8
Q

What is the prodrome for seizure?

A

Generalised and focal seizures may be preceded by prodrome
Focal seizures may have an aura – nature depends where seizure originates in brain
Focal seizures can become generalised

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9
Q

Is site relevant for TLOC?

A

No

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10
Q

What is the quality of vasovagal syncope?

A

Loss of postural tone

Convulsive movements can occur – only a few jerks

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11
Q

What is the quality of cardiac syncope?

A

Loss of postural tone

Convulsive movements can occur – only a few jerks

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12
Q

What is the quality of seizure?

A

(i) Tonic phase – stiffening of limbs with extension of back and limbs, eyes deviate upwards, may cry out involuntarily
(ii) Clonic phase – generalised flexion contractions of muscles alternating with relaxation

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13
Q

Is severity quantified for TLOC?

A

No

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14
Q

What is the time course for vasovagal syncope?

A

Usually less than 30 sec

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15
Q

What is the time course for cardiac syncope?

A

Usually less than 30 sec

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16
Q

What is the time course for seizure?

A

Usually 1-2 min

17
Q

What is the context of vasovagal syncope?

A

Usually doesn’t occur when sitting/lying

18
Q

What is the context of cardiac syncope?

A

Can occur when sitting/lying

19
Q

What is the context of seizure?

A

Can occur when sitting/lying

Can occur during sleep

20
Q

What are the precipitating factors for vasovagal syncope?

A

Fasting
Pain
Emotional events
Prolonged standing

21
Q

What are the precipitating factors for cardiac syncope?

A

Doesn’t have clear precipitating factor

Can occur on exertion

22
Q

What are the precipitating factors for seizure?

A

Usually spontaneous but can be triggered by sleep deprivation/stress

23
Q

What are the relieving factors for vasovagal syncope?

A

Lying flat assists recovery

24
Q

What are the relieving factors for cardiac syncope?

A

Self-limiting

25
Q

What are the relieving factors for seizure?

A

Self-limiting

26
Q

What are the associated features of vasovagal syncope?

A 
Tongue biting unusual
Head turning unusual
Sweaty
Pallor
No cry/moan
No frothing at mouth
Incontinence of urine may occur, although not common
27
Q

What are the associated features of cardiac syncope?

A 
Tongue biting unusual
Head turning unusual
Sweaty
Pallor
No cry/moan
No frothing at mouth
Incontinence of urine may occur, although not common
May be associated with exertion/palpitations
28
Q

What are the associated features of seizures?

A 
Tongue biting common
Head turning common
Usually not sweaty
Cyanosis
Cry/moan at onset
Frothing at mouth
Incontinence of urine may occur
29
Q

What happens after a vasovagal syncope?

A

Rapid recovery of consciousness
Rarely confused afterwards
Injury not common as protective reflexes preserved

30
Q

What happens after a cardiac syncope?

A

Rapid recovery of consciousness
Rarely confused afterwards
Injury may occur

31
Q

What happens after a seizure?

A 
Slow recovery
Period of confusion >2 min
May feel exhausted and sleepy
Muscle aches
Injury common
32
Q

What specific medical history questions do you ask for vasovagal syncope?

A

Hydration status

Autonomic dysfunction

33
Q

What specific medical history questions do you ask for cardiac syncope?

A

Cardiac disease

34
Q

What specific medical history questions do you ask for seizure?

A

Have you had a seizure before?

MD1 PCP (43 decks)

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